Provider Demographics
NPI:1427385756
Name:BRUNO, /IRMA M (MA)
Entity Type:Individual
Prefix:
First Name:/IRMA
Middle Name:M
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO EL CENTRO II LUIS MUNOZ RIVERA AVENUE #500
Mailing Address - Street 2:SUITE 233
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-536-4628
Mailing Address - Fax:787-292-8819
Practice Address - Street 1:CONDOMINIO EL CENTRO II LUIS MUNOZ RIVERA AVENUE #500
Practice Address - Street 2:SUITE 233
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-536-4628
Practice Address - Fax:787-782-3903
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist